Chapter 35: Loss, Death, and Palliative Care

Chapter 35: Loss, Death, and Palliative Care Coping with Dying Jesse was simply unable to believe that his wife was dying. The physician told Jesse that Jeanette was in the early stages of multiple myeloma, and that she might die in less than a year or she might have remissions and live another decade. Jesse and his wife had worked hard all their lives and raised two sons. Now they were both retired and financially secure and thought the best years of their lives were ahead of them. However, both Jesse and Jeanette were the type who approached a problem head on. They gathered all the relevant material they could find about multiple myeloma and assiduously studied it. Jeanette said that she did not want to mention her problem to others because she thought that she was unable to deal with “their piteous cancer looks.” She also stressed that she expected to have long remissions and to live at least 10 more years. So why trouble friends and family? As a result of her decision, Jesse was unable to share his fear and grief because he had promised to respect Jeanette’s wishes in that regard. She began a series of chemotherapeutic drugs, and friends began to notice her lethargy. They began to worry about her, but she insisted, “I’m just fine.” Six months passed with a steady downward course in Jeanette’s condition. Her sons began to suspect she had a malignancy, and one son, Rob, asked outright, “Are you hiding a serious illness from us?” She denied it, but Rob also noticed that Jesse was withdrawing into himself and that he was drinking more than usual. Rob knew something was wrong but was at a loss. When Rob went to the family physician for his annual checkup, the office nurse said, “Oh, Rob, how is your mother doing?” This resulted in him asking “Why? Is she ill?” Considering the situation and the current regulations about the protection of patient privacy, how would you respond to the son’s next if you were the nurse? As a nurse, how could you promote communication within this family to help them move toward open awareness? Chapter 36: Self-Actualization, Spirituality, and Transcendence Answers to Nursing Study Critical Thinking Questions (Text) Self-Actualization, Spirituality, and Transcendence Melba had no children but had numerous nieces and nephews, though she did not feel particularly close to any of them. She had been a nursing instructor at a community college and had enjoyed her students but had not developed a sustained relationship with any of them after they had completed her courses. At her level of nursing education, the opportunity for mentorship was lacking, though she had occasionally taken students under her wing and arranged special experiences that they particularly desired. Because she had taught several courses each year, Melba never really developed a strong affiliation to a specialty but considered herself a pediatric nurse. She had not made any major contributions to the field in terms of research or publications; a few reviews, continuing education workshops, and some nursing newsletters had really been the extent of her work outside of that which was required. Melba’s husband died in 2007, and she had felt very much alone since that time, especially after her retirement 3 years ago. Before her husband’s death, Melba had been too busy to think about the ultimate meaning of all her years of teaching and wifely activities. With time on her hands, she began to wonder what it all meant. Had she done anything meaningful? Had she really made a difference in anything or in anyone’s life? Was anyone going to remember her in any special way? So many questions were making her morose. She had never been a religious person, though her husband had been a devout Catholic. He had believed that God had a purpose for him in life, and though he was not always able to understand what it might be, he seemed to have a sense of satisfaction. She began to wonder if she should go to church—would that make her feel less depressed? One Sunday morning, Melba had decided to attend her neighborhood Catholic church, but on her way out she slipped on the icy walkway and sustained bilateral Colles’ fractures. After a brief emergency room visit for assessment, immobilization of the wrists, and medications, Melba was sent back home with an order for home health and social service assessment on the following day. Of course, she had extreme difficulty managing the most basic self-care while keeping her wrists immobilized and was very dejected. When the home health nurse arrived the next morning, to Melba’s amazement, it was a former student who had graduated 4 years previously. Melba was more chagrined than pleased and greeted her with, “Oh, I hate to have you see me so helpless. I’ve been feeling so useless, and, now with these wrists, I am totally useless.” If you were the home health nurse, how would you begin working with Melba, knowing that your visits would be limited to just a few? SCIENCE HEALTH SCIENCE NURSING NURSING RN 101

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